MEDICARE: SAMUELSON ENTERPRISES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	385HR2050X	Respite Care Camp
2	207RH0005X	Hypertension Specialist Physician
3	207RN0300X	Nephrology Physician
4	207T00000X	Neurological Surgery Physician
5	251E00000X	Home Health Agency
6	251G00000X	Community Based Hospice Care Agency	MI
7	261QC1800X	Corporate Health Clinic/Center	MI
8	305S00000X	Point of Service
9	3336H0001X	Home Infusion Therapy Pharmacy
10	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center
11	261QI0500X	Infusion Therapy Clinic/Center	MI
12	343800000X	Secured Medical Transport (VAN)
13	207P00000X	Emergency Medicine Physician
14	207RC0000X	Cardiovascular Disease Physician
15	261QH0100X	Health Service Clinic/Center	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386152296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUELSON ENTERPRISES, PLLC

Provider Business Mailing Address
First Line	:	545 ASHMUN ST UNIT 5
Second Line	:
City	:	SAULT SAINTE MARIE
State	:	MI
Zip	:	49783-1936
Country	:	US
Telephone Number	:	202-262-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3930 MOUNT VERNON DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3226
Country	:	US
Telephone Number	:	202-262-2218
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	PROF. BENSSON VARGHESE SAMUEL
Credential	:	MD, PHD, DBA, ED.D
Telephone Number	:	248-792-9864

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	10/29/2024

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Directions to “SAMUELSON ENTERPRISES, PLLC ” Practice Location

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